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Patients with cancer present a higher risk of rethrombosis and bleeding secondary to anticoagulant treatment than individuals without cancer. Given the lack of specific clinical trials, the decision regarding the optimal duration of treatment must consider multiple factors, including sex. The current study used data from the international, prospective TESEO Registry that includes consecutive patients diagnosed with cancer-associated thrombosis (CAT). Between July 2018 and December 2022, 2,823 patients were included in the TESEO Registry, 1,351 (48%) of whom were female. The most common venous thromboembolic event (VTE) in both sexes was pulmonary embolism (PE), with an incidence of 58.0% among men and 54.3% in women (p=0.045). After a median follow-up of 6.9 months (IQR, 1.9-14.4), the rethrombosis rate at the end of follow up was 10.0% in males and 15.0% in females (p=0.14). The location of the primary tumor in the gastrointestinal tract was associated with a greater risk of rethrombosis, whereas sex had no significant impact. Men presented twice as many major bleeds. Additional risk factors for major bleeding included situations of risk due to tumor site or thrombocytopenia, as well as the presence of active tumor bleeding at the time of VTE diagnosis. Overall survival was higher among women. Given the higher incidence of major bleeding among men, sex should be deemed a relevant factor when deciding on the duration of anticoagulant treatment in cancer patients.

ABSTRACT: The aim of this study was to evaluate the nutritional composition and technological properties of meat from turkeys produced under organic conditions and compare them with those of turkeys produced under conventional conditions. Twenty carcasses of female B.U.T. Premium turkeys (Aviagen Turkeys) were obtained directly from the abattoir ten h after slaughter time of animals. Ten carcasses originated from female turkeys reared under conventional intensive husbandry conditions for meat-type turkeys (on average, 5611.8 ± 196.2 g of carcass weight) and the other ten carcasses corresponded to female turkeys raised under certified organic free-range conditions (PavosBio, Ávila, Spain) (on average, 5528.5 ± 354.4 g of carcass weight). Breast, thigh and wing meat samples were analyzed from each turkey: Chemical composition, fatty acid profile, free amino acids, mineral and vitamins content, color, and texture. Meat from female turkeys reared under organic conditions presented higher fat content in breast (1.90 vs. 1.01%, P = 0.032), thigh (3.79 vs. 2.68%, P = 0.022) and wing (12.0 vs. 8.91%, P = 0.012) than meat of female turkeys reared under intensive conventional conditions. The proportion of saturated fatty acids was higher in the meat of intensively reared female turkeys than in those reared under organic conditions (42.8 vs. 38.1%, P = 0.017 in breast; 38.8 vs. 33.6%, P = 0.0053 in thigh and 40.2 vs. 33.9%, P < 0.001 in wing). On the contrary, the proportion of monounsaturated fatty acids was higher in meat of organic turkeys (41.4 vs. 35.6%, P = 0.012 in breast; 42.3 vs. 35.6%, P < 0.001 in thigh and 46.9 vs. 39.3%, P = 0.011 in wing). Concentration of riboflavin and pyridoxine was higher by 21.1% (P = 0.010) and by 154% (P = 0.006), respectively, in meat from organically raised female turkeys than in that of female turkeys reared under intensive conditions. The organic turkey meat analyzed contained a higher proportion B2 and B6, lipids and monounsaturated fatty acids, and a lower content of omega-3 polyunsaturated fatty acids.

IntroductionThis study seeks to compare expectations regarding systemic cancer treatment for advanced lung cancer from the perspectives of both patient and medical oncologist.MethodsA cross-sectional study involving 17 medical oncologists from 13 Spanish hospitals between 2021 and 2022. Patients with advanced, unresectable lung cancer were recruited prior to initiating systemic cancer treatment. Both patients and oncologists completed the NEOetic-EIT and the STAR.ResultsSeventeen medical oncologists specializing in lung cancer participated, with a mean age of 36.2 years (range 28–56); 65% were female. The study included 298 patients with advanced, unresectable lung cancer, predominantly non-small cell type (72%), and most at stage IV (77%). Most patients were retired or unemployed (71%), and married or partnered (77%). Treatment approaches varied, with 44% based on biomarkers. Oncologists had greater expectations of positive outcomes for participants with better baseline prognosis, such as ECOG 0, newly diagnosed, locally advanced, unresectable non-small cell lung cancer, and those receiving biomarker-based treatments. In contrast, patients’ treatment expectations did not vary based on sociodemographic or clinical factors. Generally, patients had high expectations of cure, in contrast to oncologists’ lower expectations, though both anticipated similar quality-of-life improvements. Patients anticipated more side effects than oncologists. Among oncologists, expectations varied by gender and decreased with age and experience, with no differences detected among patients based on gender, age, or doctor-patient relationship.ConclusionThis study reveals the complex expectations of patients and oncologists in advanced lung cancer treatment. It underscores the need for effective communication in oncology to align patient expectations with clinical realities.

This study explored the interconnections between sociodemographic elements, depression, fatigue, and exercise in patients suffering from incurable neoplasm, particularly emphasizing the mediating influence of exercise on the relationship between depression and fatigue This was a prospective, multicenter, observational study involving 15 hospitals across Spain. After three months of systemic cancer treatment, participants completed the Brief Symptom Inventory (BSI), the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) and the Fatigue Assessment Scale (FAS) to measure levels of depression, fatigue, and exercise, respectively. A total of 616 subjects participated in this study. Activity levels differed markedly according to educational attainment, marital, and work status. There was a negative correlation between physical activity and depression, and a positive correlation between depression and fatigue (β = −0.18, and β = 0.46, respectively). Additionally, physical activity inversely influenced fatigue levels (β = 0.21). Physical activity served as a partial intermediary in the link between depression and fatigue among patients with advanced, unresectable cancer. Healthcare providers are urged to consider both the physical and emotional dimensions of cancer treatment, implementing physical activity programs to enhance overall patient quality of life and mental health.

Abstract In cancer patients, psychological distress, which encompasses anxiety, depression, and somatization, arises from the complex interplay of emotional and behavioral reactions to the diagnosis and treatment, significantly influencing their functionality and quality of life. The aim was to investigate factors associated with psychological distress in cancer patients. This prospective and multicenter study, conducted by the Spanish Society of Medical Oncology (SEOM), included two cohorts of patients with cancer (localized resected or advanced unresectable). They completed surveys assessing psychological distress (BSI-18) before and after cancer treatment and coping (MINI-MAC) and spirituality (FACIT-sp) prior to therapy. A multivariable logistic regression analysis and a Structural Equation Modeling (SEM) were conducted. Between 2019 and 2022, 1807 patients were evaluated, mostly women (54%), average age 64 years. The most frequent cancers were colorectal (30%), breast (25%) and lung (18%). Men had lower levels of anxiety and depression (OR 0.66, 95% CI 0.52–0.84; OR 0.72, 95% CI 0.56–0.93). Colorectal cancer patients experienced less anxiety (OR 0.63, 95% CI 0.43–0.92), depression (OR 0.55, 95% CI 0.37–0.81), and somatization (OR 0.59, 95% CI 0.42–0.83). Patients with localized cancer and spiritual beliefs had reduced psychological distress, whereas those with anxious preoccupation had higher level. SEM revealed a relationship between psychological distress and coping strategies, emphasizing how baseline anxious preoccupation exacerbates post-treatment distress. This study suggests that age, sex, extension and location of cancer, coping and spirituality influence psychological distress in cancer patients.

The purpose of the study was to identify subgroups of advanced cancer patients who experienced grade 3–4 toxicities as reported by their oncologists as well as identify the demographic, clinical, and treatment symptom characteristics as well as QoL outcomes associated with distinct profiles of each patient. A prospective, multicenter, observational study was conducted with advanced cancer patients of 15 different hospitals across Spain. After three months of systemic cancer treatment, participants completed questionnaires that evaluated psychological distress (BSI-18), quality of life (EORTC QLQ-C30) and fatigue (FAS). The most common tumor sites for the 557 cancer patients with a mean age of 65 years were bronchopulmonary, digestive, and pancreas. Overall, 19% of patients experienced high-grade toxicities (grade 3–4) during treatment. Patients with recurrent advanced cancer, with non-adenocarcinoma cancer, undergoing chemotherapy, and a showing deteriorated baseline status (ECOG > 1) were more likely to experience higher toxicity. Patients who experienced grade 3–4 toxicities during cancer treatment had their treatment suspended in 59% of the cases. Additionally, 87% of the patients had a dose adjustment or a cycle delayed in their treatment due to a high risk of dying during treatment. Future research should focus on identifying interventions to reduce high-grade toxicities and improve quality of life in cancer patients.

Abstract Background Promoter hypermethylation of tumour suppressor genes is frequently observed during the malignant transformation of colorectal cancer (CRC). However, whether this epigenetic mechanism is functional in cancer or is a mere consequence of the carcinogenic process remains to be elucidated. Results In this work, we performed an integrative multi-omic approach to identify gene candidates with strong correlations between DNA methylation and gene expression in human CRC samples and a set of 8 colon cancer cell lines. As a proof of concept, we combined recent CRISPR-Cas9 epigenome editing tools (dCas9-TET1, dCas9-TET-IM) with a customized arrayed gRNA library to modulate the DNA methylation status of 56 promoters previously linked with strong epigenetic repression in CRC, and we monitored the potential functional consequences of this DNA methylation loss by means of a high-content cell proliferation screen. Overall, the epigenetic modulation of most of these DNA methylated regions had a mild impact on the reactivation of gene expression and on the viability of cancer cells. Interestingly, we found that epigenetic reactivation of RSPO2 in the tumour context was associated with a significant impairment in cell proliferation in p53−/− cancer cell lines, and further validation with human samples demonstrated that the epigenetic silencing of RSPO2 is a mid-late event in the adenoma to carcinoma sequence. Conclusions These results highlight the potential role of DNA methylation as a driver mechanism of CRC and paves the way for the identification of novel therapeutic windows based on the epigenetic reactivation of certain tumour suppressor genes.

Financial difficulties experienced by cancer patients negatively impact the mental health of the patients. The objective of this study was to examine the mediating role of financial difficulties between physical symptoms and depression in patients with advanced cancer. A prospective, cross-sectional design was adopted in the study. The data were collected from 861 participants with advanced cancer in 15 different tertiary hospitals in Spain. The participants’ socio-demographic characteristics were collected using a standardized self-report form. Hierarchical linear regression models were used to explore the mediating role of financial difficulties. In the results, 24% of patients reported a high level of financial difficulties. Physical symptoms were positively associated with financial difficulties and depression (β = 0.46 and β = 0.43, respectively), and financial difficulties was positively associated with depression (β = 0.26). Additionally, financial difficulties played a role in explaining the relationship between physical symptoms and depression, showing a standardized regression coefficient of 0.43 which decreased to 0.39 after the financial difficulties were controlled. Healthcare professionals should consider the importance of providing financial resources and emotional support to help patients and their families cope with the financial burden associated with cancer treatment and its symptoms.

The amount of by-products/waste in the fish industry is roughly 50%. Fish bones could be used to produce nanoparticles, which may have potential use in the food industry as a novel calcium source and at the same time, contribute to reduce waste production. The objective of this study was to evaluate the bioavailability of nano-size salmon fish bone particles compared to micro-size salmon fish bone particles, and calcium carbonate. The study was carried out in 21–28-day-old C57BL/6 male mice fed for 21 days with the experimental diets. The groups were as follows: CaCO3 0.5% Ca (CN 0.5); CaCO3 1.0% Ca (CN 1.0); salmon fish bone (SFB) microparticles 0.5% Ca (MP 0.5); SFB microparticles 1.0% Ca (MP 1.0); SFB nanoparticles 0.5% Ca (NP 0.5); and SFB nanoparticles 1.0% Ca (NP 1.0). Calcium bioavailability, defined as the percent calcium in femur showed an increasing trend from CN 0.5 to NP 1.0 group. According to ANCOVA, the greatest Ca content was observed in the NP 1.0 group compared with all groups but NP 0.5. In conclusion, in a murine model, salmon fish bone nanoparticles present higher calcium bioavailability than salmon fish bone microparticles, and both, in turn, have better bioavailability than calcium carbonate.

In the Chilean population, calcium consumption is deficient. Therefore, several strategies have been implemented to increase calcium intake, such as consuming dairy products and supplements. In this study, an ingredient composed of bone flour (BF) and protein hydrolysate (PH) obtained from salmon frame was used as an innovative source of calcium. The objective was to evaluate the effect of the incorporation of BF and PH in a 1:1 ratio (providing two calcium concentrations to the nuggets, 75 and 125 mg/100 g) on calcium content and sensory attributes of salmon nuggets submitted to baking or shallow frying. Proximal chemical analyses, fatty acid composition, calcium content, and sensory evaluation (acceptability and check-all-that-apply test) were tested in the nuggets. The incorporation of BF/PH (1:1) in both concentrations increased the calcium content of salmon nuggets being higher for the 125 mg/100 g. On the other hand, no negative effects were observed on sensory properties where all samples showed good overall acceptability for baked and fried nuggets. Therefore, the incorporation of BF/PH (1:1) into salmon nuggets enhances the nutritional quality of these products by providing a higher calcium content without significantly affecting their sensory properties.

The therapeutic alliance is an important factor in successful cancer treatment, particularly for those with advanced cancer. This study aims to determine how the therapeutic alliance relates to prognostic preferences and satisfaction with the physician and medical care among patients with advanced cancer. We conducted a cross-sectional study to explore the therapeutic relationship, trust, satisfaction with healthcare, and prognostic preferences among 946 patients with advanced cancer at 15 tertiary hospitals in Spain. Participants completed questionnaires with self-reported measures. Most were male, aged > 65 years, with bronchopulmonary (29%) or colorectal (16%) tumors and metastatic disease at diagnosis. Results revealed that 84% of patients had a good therapeutic alliance. Collaborative and affective bond was positively associated with a preference to know the prognosis and satisfaction with care and decision. There was no difference in a therapeutic alliance based on clinical or sociodemographic factors. The therapeutic alliance between patient and physician is essential for successful treatment outcomes and better overall satisfaction. Therefore, it is vital for healthcare providers to focus on establishing and maintaining a strong relationship with their patients. To achieve this, transparency and care should be prioritized, as well as respect for the preferences of patients regarding the prognosis of their illness.

Abstract Purpose Patients with advanced cancer suffer significant decline of their psychological state. A rapid and reliable evaluation of this state is essential to detect and treat it and improve quality of life. The aim was to probe the usefulness of the emotional function (EF) subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EF-EORTC-QLQ-C30) to assess psychological distress in cancer patients. Methods This is a multicenter, prospective, observational study involving 15 Spanish hospitals. Patients diagnosed with unresectable advanced thoracic or colorectal cancer were included. Participants completed the Brief Symptom Inventory 18 (BSI-18), the current the gold standard, and the EF-EORTC-QLQ-C30 to assess their psychological distress prior to initiating systemic antineoplastic treatment. Accuracy, sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) were calculated. Results The sample comprised 639 patients: 283 with advanced thoracic cancer and 356 with advanced colorectal cancer. According to the BSI scale, 74% and 66% displayed psychological distress with an EF-EORTC-QLQ-C30 accuracy of 79% and 76% in detecting psychological distress in individuals with advanced thoracic and colorectal cancer, respectively. Sensitivity was 79 and 75% and specificity was 79 and 77% with a PPV of 92 and 86% and a NPV of 56 and 61% (scale cut-off point, 75) for patients with advanced thoracic and colorectal cancer, respectively. The mean AUC for thoracic cancer was 0.84 and, for colorectal cancer, it was 0.85. Conclusion This study reveals that the EF-EORTC-QLQ-C30 subscale is a simple and effective tool for detecting psychological distress in people with advanced cancer.

Melanoma is the most aggressive form of skin cancer and the leading cause of death from cutaneous tumors. Several studies have associated alterations in the TERT promoter region (pTERT) with gene overexpression, aggressiveness and poor prognosis of the disease. The aim of this study was to clarify the role of pTERT molecular status in paired samples of primary melanoma and metastasis using tissue and plasma to establish a correlation with disease progression and survival.A total of 88 FFPE tissue samples from 53 patients with advanced melanoma were analyzed. Of these, 35 had paired samples. We also examined cfDNA samples from plasma of 25 patients. We detected a good correlation between primary tumors and metastases in pTERT mutation and methylation status. We were also able to identify pTERT mutations in plasma samples that correlated with mutational status in tissue samples. Interestingly, the C250T mutation was associated with worse survival and higher TERT mRNA expression, compared to the other most common mutation: C228T. In addition, hyper-methylation of the promoter region seems to be related to the progression of pTERT wild type (WT) patients. These results suggest that TERT gene alterations plays an important role during tumor progression, with the detection of the C250T mutation in tissue and plasma as a potential biomarker of poor prognosis in patients with advanced melanoma.

Abstract Introduction Most cancers occur in older individuals, who are more vulnerable due to functional impairment, multiple comorbidities, cognitive impairment, and lack of socio-familial support. These can undermine patients’ sense of dignity. This study seeks to compare dignity scores in older patients with advanced cancer on sociodemographic and clinical variables and analyze the predictive value of anxiety, depression, functional limitations, and social support on dignity scores. Methods A prospective, multicenter, observational study conducted with participation of 15 hospitals in Spain from February 2020 to October 2021. Patients with newly-diagnosed, advanced cancer completed the dignity (PPDS), anxiety and depression (BSI), Social Support (Duke–UNC-11), and functional limitations (EORTC-C30) scales. Lineal regression analyses explored the effects of anxiety, depression, functional status, and social support on dignity, adjusting for sociodemographic and clinical variables. Results A total of 180 subjects participated in this study. The results of the correlation analysis revealed that dignity correlated negatively with anxiety, depression, and sex, and positively with social support, functional status, and longer estimated survival. Thus, women, and more anxious and depressed individuals scored lower on the dignity scale, whereas patients with more social support, fewer functional limitations, and longer estimated survival scored higher. Conclusion In conclusion, being female, having a lower educational level, lower estimated survival, depression, anxiety, less social support, and limited functionality are correlated with less dignity in the elderly with advanced cancer. It is a priority to manage both physical and psychological symptoms in patients with unresectable advanced cancer to mitigate psychological distress and increase their sense of dignity.

Abstract Background The purpose of this study was to investigate the sociodemographic factors related to psychological distress, spirituality, and resilience, and to examine the mediating role of spirituality with respect to psychological distress and resilience in patients with advanced, unresectable cancer during the Covid-19 pandemic. Methods A prospective, cross-sectional design was adopted. Data were collected from 636 participants with advanced cancer at 15 tertiary hospitals in Spain between February 2019 and December 2021. Participants completed self-report measures: Brief Resilient Coping Scale (BRCS), Brief Symptom Inventory (BSI-18), and Spiritual well-being (FACIT-Sp). Hierarchical linear regression models were used to explore the mediating role of spirituality. Results Spirituality was significantly different according to the person’s age and marital status. Psychological distress accounted for 12% of the variance in resilience (β = − 0.32, p

This is a summary of the clustering workshop at the Sustainable Places 2022 conference. The H2020 funded projects LIGHTNESS, HESTIA, LocalRES and CREATORS came together to shed light on the importance of engaging people and unlocking the potential of technologies to promote energy communities and meet the EU’s ambition of a joint net-zero emission of greenhouse gases by the year 2050. To ensure a people-centric, sustainable, just, and innovative energy future, citizens and experts must be brought into dialogue to co-design new ways of organising around energy.

Blastocystis is an intestinal protist that presents worldwide distribution, colonizes animal and human hosts, and is classified into at least 34 ribosomal subtypes (STs). Herein, we conducted an update based on studies reporting Blastocystis-positive samples obtained from diverse hosts in the Americas. We described the distribution throughout the continent by assembling maps representing the distribution of STs and the most important 18S-rRNA alleles. Thirty-nine articles from the previous study, “A summary of Blastocystis subtypes in North and South America,” and forty-one additional articles from March 2019 to March 2022 were considered. The most common subtype described was ST3, representing the highest percentage of positive samples. Other recently identified STs include ST12, ST13, and ST16 in humans, and ST10, ST14, and ST17 in animals. Novel subtypes have also been described in this continent. We assembled and updated the distribution of Blastocystis in the Americas. We hope this delivers new understandings and knowledge of this microorganism’s prevalence and genetic diversity.

El estudio se fundamenta en la necesidad de promover metodologías colaborativas en la formación del profesorado, implicando al estudiante en la construcción de su propio proceso formativo, mediante el uso de estrategias educativas inclusivas. El objetivo principal es “Desarrollar metodologías participativas en la formación docente, basadas en estrategias didácticas inclusivas y los principios del Diseño Universal para el Aprendizaje, DUA”. La metodología utilizada es cualitativa. La recogida de datos se realiza mediante la creación de 20 Grupos de Discusión en los que se genera diálogo a partir de los interrogantes planteados. Las conclusiones y su discusión se presentan con base en los objetivos del estudio y revelan que las metodologías activas y participativas se desarrollan mediante estrategias didácticas, siendo el manejo de habilidades y destrezas desigual, ya que su uso difiere según la estrategia.

The consumption of dietary fiber (DF) has been associated with a reduced incidence of non-communicable diseases. Despite various strategies implemented worldwide to increase DF intake, it remains low. Therefore, the development of new fiber-rich food products that are widely consumed could be a strategy to improve DF intake. In this study, an agro-industrial by-product, pomegranate peel powder (PPP), was used as an innovative source of DF and antioxidant. The objective was to develop a bread enriched with DF, antioxidants, and sensory characteristics by partially replacing wheat flour (WF) with PPP at levels of 0%, 2.5%, 5%, 7.5%, and 10%. Bread with 2.5% and 5% PPP was chosen for a clinical trial to evaluate glycemic response (GR) in healthy subjects and determine the bread’s glycemic index (GI). As the percentage of PPP increased, both the DF and total polyphenol content increased significantly. The highest overall acceptability was achieved with bread containing up to 5% PPP. Consumption of bread with 2.5% and 5.0% PPP significantly reduced the GI compared to the control bread, while the decrease in GR was not significant. PPP could be a potential food and low-cost ingredient to improve the bread’s nutritional quality through its contribution to DF and antioxidants.

The article aims to analyze, based on a multiple case study, the discourses of the individuals that promote social innovation (SI) initiatives for the reuse of abandoned riverside landscapes, connecting SI theory with land reutilization and management through discourse analysis. Following a qualitative methodology, the text analyses the characteristics of the promoting actors, the discourses storylines and the main actors’ discourses, describing some relevant aspects regarding SI, such as why, where and when it takes place; how it has been developed; who has promoted it; its main results, as well as the barriers faced for its development and future opportunities for the territory. Two main discursive tendencies are identified: a negationist trend and a possibilistic one, adopted by individuals who are not promoting initiatives of SI and by promoters of these kinds of experiences, respectively. Possibilistic discourse underlines the coherent articulation between the economic-managerial dimension and the emotional-territorial one, and there is, in this case, a tendency to change in the visions of the territory, reconfiguring the social practices of the actors involved in these initiatives of SI. We conclude that discourses behind successful processes of SI are associated with certain positions on the interrelationships between individual- collective-institutionality-nature and that there is a complex articulation between discourses on SI and social practices developed by individuals as part of these initiatives, in such a reflexive way that discourses advance the desired changes, drawing and modifying the future vision of the subjects, and making the impossible possible.

ObjectiveLoss of dignity is one of the main reasons for wishing for an early death in patients with incurable diseases such as cancer and is strongly associated with psychological distress and loss of quality of life. The present study aims to analyze the perceived dignity of patients with advanced cancer undergoing systemic treatment and their relationship with sociodemographic, clinical, and psychological factors.MethodsA prospective, cross-sectional, multicenter study was conducted in 15 oncology departments in Spain. Patients with locally advanced, unresectable, or metastatic cancer who were candidates for systemic treatment were included. Participants completed demographic information and Palliative Patients’ Dignity Scale, Brief Symptom Inventory, Mental Adjustment to Cancer, Functional Social Support Questionnaire, and Illness Uncertainty.ResultsA total of 508 patients were recruited between February 2020 and October 2021. Most were male, aged > 65 years, with digestive tumors (41%), and metastatic disease at diagnosis. Subjects were classified as having low (56%, N = 283) or high (44%, N = 225) perceived dignity. Patients ≥ 65 years, with worse baseline status (ECOG ≥ 1), and worse estimated 18-month survival had lower levels of perceived dignity. People with lower perceived dignity scored higher for anxious preoccupation and hopelessness and lower for positive attitude. They also displayed higher levels of anxiety, depression, and somatic symptoms, greater uncertainty, and less social support.ConclusionSelf-perceived dignity in advancer cancer patients is significantly associated with psychological factors, psychological distress, uncertainty, less social support. Knowledge of these specific interactions is importance for adequate, comprehensive palliative care.

Reseña de la obra de Sagastizabal, M. (2019). La triple presencia. Estudio sobre el trabajo doméstico-familiar, el empleo y la participación sociopolítica. Bilbao: UPV-EHU. 335 pp.

Abstract Background 22q11.2 duplication syndrome (Dup22q11.2) has reduced penetrance and variable expressivity. Those affected may have intellectual disabilities, dysmorphic facial features, and ocular alterations such as ptosis, hypertelorism, nystagmus, and chorioretinal coloboma. The prevalence of this syndrome is unknown, there are only approximately 100 cases reported. However Dup22q11.2 should have a similar prevalence of DiGeorge syndrome (1 in each 4000 new-borns), in which the same chromosomal region that is duplicated in Dup22q11.2 is deleted. Case presentation We report a patient with intellectual disability, psychomotor development delay, hearing loss with disyllable pronunciation only, hyperactivity, self-harm, hetero-aggressive behaviour, facial dysmorphism, left facial paralysis, post-axial polydactyly, and for the first time in patients with Dup22q11.2, optic nerve coloboma and dysplasia in optic nerve. Array comparative genomic hybridization showed a 22q11.23 duplication of 1.306 million base pairs. Conclusions New ocular findings in Dup22q11.2 syndrome, such as coloboma and dysplasia in the optic nerve, are reported here, contributing to the phenotypic characterization of a rarely diagnosed genetic syndrome. A complete characterization of the phenotype is necessary to increase the rate of clinical suspicion and then the genetic diagnostic. In addition, through bioinformatics analysis of the genes mapped to the 22q11.2 region, it is proposed that deregulation of the SPECC1L gene could be implicated in the development of ocular coloboma.

This research explores the results that an examinee would obtain if taking a multiple-choice questions test in which they have doubts as to what the true answer is among different options. This problem is analyzed by making use of combinatorics and analytical and sampling methodologies. The Spanish exam through which doctors become medical specialists has been employed as an example. Although it is difficult to imagine that there are candidates who respond randomly to all the questions of such an exam, it is common that they may doubt over what the correct answer is in some questions. The exam consists of a total of 210 multiple-choice questions with 4 answer options. The cut-off mark is calculated as one-third of the average of the 10 best marks in the exam. According to the results obtained, it is possible to affirm that in the case of doubting over two or three of the four possible answers in certain group questions, answering all of them will in most cases lead to obtaining a positive result. Moreover, in the case of doubting between two answer options in all the questions of the MIR test, it would be possible to exceed the cut-off mark.

BackgroundBreast cancer is one of the most prevalent diseases in women. Prevention and treatments have lowered mortality; nevertheless, the impact of the diagnosis and treatment continue to impact all aspects of patients' lives (physical, emotional, cognitive, social, and spiritual).ObjectiveThis study seeks to explore the experiences of the different stages women with breast cancer go through by means of a patient journey.MethodsThis is a qualitative study in which 21 women with breast cancer or survivors were interviewed. Participants were recruited at 9 large hospitals in Spain and intentional sampling methods were applied. Data were collected using a semi-structured interview that was elaborated with the help of medical oncologists, nurses, and psycho-oncologists. Data were processed by adopting a thematic analysis approach.ResultsThe diagnosis and treatment of breast cancer entails a radical change in patients' day-to-day that linger in the mid-term. Seven stages have been defined that correspond to the different medical processes: diagnosis/unmasking stage, surgery/cleaning out, chemotherapy/loss of identity, radiotherapy/transition to normality, follow-up care/the "new" day-to-day, relapse/starting over, and metastatic/time-limited chronic breast cancer. The most relevant aspects of each are highlighted, as are the various cross-sectional aspects that manifest throughout the entire patient journey.ConclusionsComprehending patients' experiences in depth facilitates the detection of situations of risk and helps to identify key moments when more precise information should be offered. Similarly, preparing the women for the process they must confront and for the sequelae of medical treatments would contribute to decreasing their uncertainty and concern, and to improving their quality-of-life.

BackgroundThe current cancer care system must be improved if we are to have in-depth knowledge about breast cancer patients' experiences throughout all the stages of their disease.AimThis study seeks to describe breast cancer patients' experience over the course of the various stages of illness by means of a journey model.MethodsThis is a qualitative descriptive study. Individual, semi-structured interviews will be administered to women with breast cancer and breast cancer survivors. Patients will be recruited from nine large hospitals in Spain and intentional sampling will be used. Data will be collected by means of a semi-structured interview that was elaborated with the help of medical oncologists, nurses, and psycho-oncologists. Data will be processed adopting a thematic analysis approach.DiscussionThe outcomes of this study will afford new insights into breast cancer patients' experiences, providing guidance to improve the care given to these individuals. This protocol aims to describe the journey of patients with breast cancer through the healthcare system to establish baseline data that will serve as the basis for the development and implementation of a patient-centered, evidence-based clinical pathway.

Advanced gastric cancer is one of the most thrombogenic neoplasms. However, genetic mechanisms underlying this complication remain obscure, and the molecular and histological heterogeneity of this neoplasm hinder the identification of thrombotic biomarkers. Therefore, our main objective was to identify genes related to thrombosis regardless of Lauren subtypes. Furthermore, in a secondary exploratory study, we seek to discover thrombosis-associated genes that were specific to each TCGA molecular subtype. We designed a nested case-control study using the cohort of the AGAMENON national advanced gastric cancer registry. Ninety-seven patients were selected—48 with and 49 without venous thromboembolism (using propensity score matching to adjust for confounding factors)—and a differential gene expression array stratified by Lauren histopathological subtypes was carried out in primary tumor samples. For the secondary objective, the aforementioned differential expression analysis was conducted for each TCGA group. Fifteen genes were determined to be associated with thrombosis with the same expression trend in both the intestinal and diffuse subtypes. In thrombotic subjects, CRELD1, KCNH8, CRYGN, MAGEB16, SAA1, ARL11, CCDC169, TRMT61A, RIPPLY3 and PLA2G6 were underexpressed (adjusted-p < 0.05), while PRKD3, MIR5683, SDCBP, EPS8 and CDC45 were overexpressed (adjusted-p < 0.05), and correlated, by logistic regression, with lower or higher thrombotic risk, respectively, in the overall cohort. In each TCGA molecular subtype, we identified a series of genes differentially expressed in thrombosis that appear to be subtype-specific. We have identified several genes associated with venous thromboembolism in advanced gastric cancer that are common to Lauren intestinal and diffuse subtypes. Should these genetic factors be validated in the future, they could be complemented with existing clinical models to bolster the ability to predict thrombotic risk in individuals with advanced gastric adenocarcinoma.

Abstract Background Treatment with nab-paclitaxel plus gemcitabine increases survival in patients with metastatic pancreatic cancer. However, the assessment of treatment efficacy and safety in non-selected patients in a real-life setting may provide useful information to support decision-making processes in routine practice. Methods Retrospective, multicenter study including patients with metastatic pancreatic cancer, who started first-line treatment with nab-paclitaxel plus gemcitabine between December 2013 and June 2015 according to routine clinical practice. In addition to describing the treatment pattern, overall survival (OS) and progression-free survival (PFS) were assessed for the total sample and the exploratory subgroups based on the treatment and patients’ clinical characteristics. Results All 210 eligible patients had a median age of 65.0 years (range 37–81). Metastatic pancreatic adenocarcinoma was recurrent in 46 (21.9%) patients and de novo in 164 (78.1%); 38 (18%) patients had a biliary stent. At baseline, 33 (18.1%) patients had an ECOG performance status ≥2. Patients received a median of four cycles of treatment (range 1–21), with a median duration of 3.5 months; 137 (65.2%) patients had a dose reduction of nab-paclitaxel and/or gemcitabine during treatment, and 33 (17.2%) discontinued treatment due to toxicity. Relative dose intensity (RDI) for nab-paclitaxel, gemcitabine, and the combined treatment was 66.7%. Median OS was 7.2 months (95% CI 6.0–8.5), and median PFS was 5.0 months (95% CI 4.3–5.9); 50 patients achieved either a partial or complete response (ORR 24.6%). OS was influenced by baseline ECOG PS, NLR and CA 19.9, but not by age ≥ 70 years and/or the presence of hepatobiliary stent or RDI 3 vs. ≤ 3 (p = 0.043), and baseline CA 19.9 > 37 U/mL vs. ≤37 U/mL (p = 0.004). Conclusions Nab-Paclitaxel plus gemcitabine remain effective in a real-life setting, despite the high burden of dose reductions and poorer performance of these patients. A nomogram to predict survival using baseline ECOG performance status, NLR and CA 19.9 is proposed.

Detectar una actitud de afrontamiento estoica en los pacientes con cáncer es importante porque puede favorecer o dificultar el tratamiento oncológico. Objetivo: En este trabajo, analizamos si en función de la edad, el género, la presencia de dolor y el tiempo transcurrido desde que empezaron los síntomas hasta el diagnóstico del cáncer, podemos asignar a las conductas estoicas un valor positivo o negativo, como factor de protección o de riesgo en los pacientes. Material y Métodos: evaluamos 540 pacientes que acudieron a la consulta de Oncología Médica para valoración de tratamiento adyuvante tras una cirugía oncológica, entre junio del 2015 y diciembre del 2016. Los datos clínicos y demográficos se obtuvieron a través de la entrevista médica y fueron: género, edad, estado civil, nivel educativo, área ocupacional, localización del tumor, estadio y tiempo trascurrido desde la presencia de los síntomas y la consulta al médico. Se administraron en papel y presencialmente los siguientes cuestionarios: Inventario de Dolor Breve, Brief Symptom Inventory y Liverpool Stoicism Scale. Resultados: Los hombres de la muestra mostraron casi 5 veces más probabilidad de presentar altas puntuaciones en estoicismo que las mujeres y 7 veces más si se asocia un estado de ánimo decaído y edad avanzada. El estoicismo fue mayor en los pacientes de más edad. No se ha hallado relación entre el estoicismo y las escalas de dolor. Conclusión: Las tres características que discriminan mejor entre los pacientes con altas y/o bajas puntuaciones en estoicismo son el género, la edad y el estado de ánimo depresivo. El hecho de que el estoicismo esté asociado a hombres ancianos con depresión nos hace pensar que el estoicismo debe ser considerado más como un factor de riesgo que de protección. La madurez relacionada con la edad conlleva inevitablemente una mayor aceptación de las pérdidas y una propensión a ocultar el dolor, o a no buscar ayuda para evitar mostrar debilidad. Ante esta situación es importante contar con la información que nos proporciona la familia y reconocer la importancia del apoyo familiar sobre a estas personas que pueden ser de entrada más vulnerables.

L-PRF (leukocyte- and platelet-rich fibrin) is one of the four families of platelet concentrates for surgical use and is widely used in oral and maxillofacial regenerative therapies. The first objective of this article was to evaluate the mechanical vibrations appearing during centrifugation in four models of commercially available table-top centrifuges used to produce L-PRF and the impact of the centrifuge characteristics on the cell and fibrin architecture of a L-PRF clot and membrane. The second objective of this article was to evaluate how changing some parameters of the L-PRF protocol may influence its biological signature, independently from the characteristics of the centrifuge. In the first part, four different commercially available centrifuges were used to produce L-PRF, following the original L-PRF production method (glass-coated plastic tubes, 400 g force, 12 minutes). The tested systems were the original L-PRF centrifuge (Intra-Spin, Intra-Lock, the only CE and FDA cleared system for the preparation of L-PRF) and three other laboratory centrifuges (not CE/FDA cleared for L-PRF): A-PRF 12 (Advanced PRF, Process), LW-UPD8 (LW Scientific) and Salvin 1310 (Salvin Dental). Each centrifuge was opened for inspection, two accelerometers were installed (one radial, one vertical), and data were collected with a spectrum analyzer in two configurations (full-load or half load). All clots and membranes were collected into a sterile surgical box (Xpression kit, Intra-Lock). The exact macroscopic (weights, sizes) and microscopic (photonic and scanning electron microscopy SEM) characteristics of the L-PRF produced with these four different machines were evaluated. In the second part, venous blood was taken in two groups, respectively, Intra-Spin 9 ml glass-coated plastic tubes (Intra-Lock) and A-PRF 10 ml glass tubes (Process). Tubes were immediately centrifuged at 2700 rpm (around 400 g) during 12 minutes to produce L-PRF or at 1500 rpm during 14 minutes to produce A-PRF. All centrifugations were done using the original L-PRF centrifuge (Intra-Spin), as recommended by the two manufacturers. Half of the membranes were placed individually in culture media and transferred in a new tube at seven experimental times (up to 7 days). The releases of transforming growth factor β-1 (TGFβ-1), platelet derived growth factor AB (PDGF-AB), vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2) were quantified using ELISA kits at these seven experimental times. The remaining membranes were used to evaluate the initial quantity of growth factors of the L-PRF and A-PRF membranes, through forcible extraction. Very significant differences in the level of vibrations at each rotational speed were observed between the four tested centrifuges. The original L-PRF centrifuge (Intra-Spin) was by far the most stable machine in all configurations and always remained under the threshold of resonance, unlike the three other tested machines. At the classical speed of production of L-PRF, the level of undesirable vibrations on the original centrifuge was between 4.5 and 6 times lower than with other centrifuges. Intra-Spin showed the lowest temperature of the tubes. A-PRF and Salvin were both associated with a significant increase in temperature in the tube. Intra-Spin produced the heaviest clot and quantity of exudate among the four techniques. A-PRF and LW produced much lighter, shorter and narrower clots and membranes than the two other centrifuges. Light microscopy analysis showed relatively similar features for all L-PRF types (concentration of cell bodies in the first half). However, SEM illustrated considerable differences between samples. The original Intra-Spin L-PRF showed a strongly polymerized thick fibrin matrix and all cells appeared alive with a normal shape, including the textured surface aspect of activated lymphocytes. The A-PRF, Salvin and LW PRF-like membranes presented a lightly polymerized slim fibrin gel and most of the visible cell bodies appeared destroyed (squashed or shrunk). In the second part of this study, the slow release of the three tested growth factors from original L-PRF membranes was significantly stronger (more than twice stronger, p

Background and Objectives: The aim of the present research is to study the questions used in the 2018 MIR exam (a test that allows access to specialized medical training in Spain), describe their psychometric properties, and evaluate their quality. Materials and Methods: This analysis is performed with the help of classical test theory (CTT) and item response theory (IRT). The answers given to the test questions by a total of 3868 physicians are analyzed. Results: According to CTT, the average difficulty index for all of the test questions was 0.629, which falls into the acceptable category. The average difficulty index with correction for random effects was 0.515, which corresponds to a value within the optimal range. The mean discrimination index was 0.277, which is in the good category, while the mean point biserial correlation coefficient, with a value of 0.275 fits in the regular category. The values of difficulty and discrimination calculated according to the model of two parameters of the IRT seem adequate with average values of −0.389 and 0.677. The Cronbach alpha score obtained for the overall test was 0.944. This value is considered as very good. Conclusions: A decrease was observed in the average values of discrimination in the last three calls, which may be related to the greater proportion of Spanish graduates that take the exam in the same year of finalization of their studies in Medicine.

Entre 1865 y 1880 la educación secundaria en los liceos de provincia se desenvolvió de acuerdo a un plan de estudios humanista y orientado a la formación profesional, de acuerdo al modelo del Instituto Nacional. Sin embargo, la demanda por educación secundaria en las provincias siguió su propio derrotero, articulada entre las circunstancias socioeconómicas locales y los dilemas propios del sistema nacional de educación. A través del análisis estadístico de los índices de matrícula y deserción, este trabajo explica el desajuste entre oferta estatal y demanda social. La concentración de alumnos en la clase preparatoria y el primer curso secundario, por una parte, y la deserción escolar observada en clases secundarias y superiores, por otra,reflejan una demanda por una enseñanza práctica y técnica, al mismo tiempo que dan cuenta del liceo como un espacio educativo en configuración entre la escuela y la universidad.

Antecedentes: La evaluación de la calidad de vida es un elemento clave en el tratamiento curativo y paliativo de pacientes con cáncer. El tratamiento del cáncer de cuello uterino tiene secuelas importantes que dificultan la calidad de vida de las pacientes. Objetivo: Evaluar la calidad de vida a pacientes tratadas por cáncer de cuello uterino en la Fundación Arturo López Pérez (FALP), utilizando las encuestas para cáncer en general (QOL-C30) y específica para cáncer de cuello (QOL-CX24) de la European Organizaron for Research and Treatment of Cancer (EORTC). Resultados: Evaluamos la calidad de vida a 72 pacientes. Fueron relevantes los problemas emocionales y económicos, el cansancio, la imagen corporal, los síntomas menopáusicos y todo lo relacionado con la actividad sexual. Conclusión: La evaluación de la calidad de vida debe ser parte del enfoque integral, para una adecuada toma de decisiones y detección de problemas ocultos.Background: Evaluating quality of Life is a key element in the curative treatment and palliative treatment of cancer patients. Cervical cancer treatment has important sequels that are an obstacle to patients' quality of life. Objective: To evaluate the quality of life to cervical cancer patients treated in the Fundación Arturo López Pérez (FALP), using surveys for cancer in general (QOL-C30) and specific to cervical cancer (QOL-CX24) from the European Organization for Research and Treatment of Cancer (EORTC). Results: We evaluated quality of life of 72 patients. Emotional and economical problems, tiredness, body image, menopausical symptoms and everything related to sexual activity were found to be relevant. Conclusion: To evaluate the quality of life, must be part of general approach of this patients, to take good decisions and early detection of hidden problems.